Psychiatric medications, science, marketing, psychiatry in general, and occasionally clinical psychology. Questioning the role of key opinion leaders and the use of "science" to promote commercial ends rather than the needs of people with mental health concerns.

Tuesday, January 23, 2007

I have ranted before about the alleged chemical imbalance in depression. Any time I've seen a commercial for any of the SSRI's, I've just shaken my head (0r banged it against the wall), as the ads love to tout how "experts" (i.e., their marketing department ?) believe that depression is caused by some sort of chemical imbalance. The evidence, as you can read here, is scant, at best, to support such an assertion.

Well, Wyeth is still on the chemical imbalance train with their knockoff of their current bestselling antidepressant Effexor, which may be gracing your pharmacy before long. The new drug is called Pristiq and Wyeth is offering up the following as part of its early PR campaign for the drug:

In the area of depression, Pristiq is expected to improve the balance of serotonin and norepinephrine as compared with serotonin reuptake inhibitors (SSRI) because of its pharmacologic profile as a dual reuptake inhibitor.

Well, whoopee! Will it work any better than antidepressants that attempt to target either norepinephrine or serotonin? Nope. Why? Because a reliable imbalance of either neurotransmitter has never been found in depression. That's right -- never. But Wyeth continues to run with the chemical imbalance program because a lot of people have been indoctrinated, through advertising or perhaps through teachers who themselves lacked much education on the topic, to buy into this whole chemical imbalance deal.

I'm not saying that biology does not impact depression. I am saying that our current level of understanding in this area is much more speculation than it is fact. I do not believe there is a single serious scientist who would stick his/her name behind the simple "chemical imbalance" theory of depression.

And the name Pristiq? It would appear that Wyeth is aiming for a close resemblance to "Pristine," which is a bit ironic given the side effect profile of Pristiq (which will likely resemble that of Effexor closely).

8 comments:

You do see a clear chemical imbalance in many forms of depression: the endocrine feedback loop between the hypothalamus, pituitary and adrenal glands is generally not even close to normal.

The SSRIs, SNRIS, and NRIs do, which is mimic serotonin or noradrenalin, can also be achieved with aminoacids you can, or could, buy at any healthfood store.

The thinking today, is that the SSRIs cause changes to gene expression that affect this feedback loop, which, if the DEA was talking, would be deemed to be brain damage.

Trytophan and similar compounds are serotonin precursors; tyrosine is the noradrenalin precursor of choice. Best of all, as these are all natural compounds, they biodegrade, and don't build up in our drinking supplies.

For reasons that have nothing to do with science, conferences on the therapeutic use of aminoacids are few and far between.

“CL Psych Location:United States I'm an academic with a respectable amount of clinical experience and no drug industry funding. Given my lack of time, don't expect multiple daily updates. Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts, and you'll probably pick up on these pet peeves before long...” --- CL Psych

Hi doc,

Sorry, but I’ve been busy doing my thing but I do try to catch your commentary from time to time.

I’m fascinated as a lay-person and long-time support person to many of your statements and positions such as the above statement and the following:

“I have ranted before about the alleged chemical imbalance in depression.” --- CL Psych

“I'm not saying that biology does not impact depression. I am saying that our current level of understanding in this area is much more speculation than it is fact. I do not believe there is a single serious scientist who would stick his/her name behind the simple "chemical imbalance" theory of depression.” --- CL Psych

Etc, etc, etc. Seems to me you have a negative advocacy going here and I “pick up on these pet peeves”.

You’re knocking meds, you’ve knocked the VNS Therapy and I’ll presume just about everything else; just what in your profession do you suggest for patients that have suffered for decades, tried numerous talk-therapy options, tried different dietary approaches, vitamins and supplements, holistic therapies, medications and the like without any favorable or sustainable responses?

I mentioned our brief discussion to my spouse’s psychiatrist and he simply said, “Ask the fellow what alternative he would suggest for his patients that nothing seems to work?”

Okay, I understand your negative advocacy and need to find fault, so what alternative would you suggest? Isn’t the patient’s wellness of primary concern to you?

"anonymous" clearly doesn't understand what the mind is. Treating a persons brain like any other malfunctioning organ is myopic. What we think ,believe and physically do, makes our brain chemistry.

"herb" doesn't seem to know mankind has had some trouble being happy since the dawn of time. He also seems to think happiness comes from a pill or a treatment.

Two sources to read google "sugar pill hard to beat" look for washington postthe other is http://www.ahrp.org/cms/content/view/435/94/ "The subject--mind over matter--would have been off-limits just a few yearsago when biological psychiatry held an iron grip on scientific discourseabout the brain, having banished even the concept of mind."

Thank you. First, I am glad that you survived and that I’ve now met a man who clearly understands “what the mind is.”

Thank you also for sharing with me my lack of understanding that “mankind has had some trouble being happy since the dawn of time.”

Also thank you for elucidating upon the fact that maybe not “happiness comes from a pill or a treatment.” Well doesn’t it?

Now that I’m done with my tongue and cheek humor, the population of patients and the illness and experiences that are shared with me and what I have come to know; these patients do concern themselves with happiness but more pressing and importantly is relief from their pain, anguish and suffering and a little detail like just staying alive.

And while I do not dismiss mind, psychotherapy etc, quite often these therapies are ineffective until these unique individuals can be stabilized to possibly use their minds or wherewithal to right themselves back from the brink of termination on a track toward wellness.

I’ll leave mankind’s unhappiness, neurosis, mind, sugar pills and placebos to your hyperopia and I’ll deal with that which is at hand.

herb.I'm sorry but I didn't catch your tongue and cheek humor.(and I had to look up "hyperopia")I believe that adults should have the right to purchase any drug they so chose. This means painkilling drugs like opium and morphine from a drug store without a doctors prescription.

Sugar pills(placibo) do match and exceed modern psychiatric drugs against depression, if you read the studies.I also mentioned the brain imaging from cognitive behavioraltherapy.I'm sorry if this upsets you.

I'm sorry but I don't know who, or what you do, but I understand that VNS is vagus nerve stimulation. People with problems come to you looking for answers? what are the problems?

Interesting discussion. To answer Herb, I’m not saying that medications don’t sometimes help people get better. What I am saying is that the placebo effect accounts for well over half (actually, about 80%) of the antidepressant effect. So people are getting better for reasons that we frankly don’t understand. Though you stated that I am using “negative advocacy,” what I believe I am doing is trying to point to research findings. When research clearly says that placebo is more accountable for changes in depression than is the specific action of the drugs or devices (ECT, VNS, etc.), then I point that out, as the ads for various antidepressants fail to paint an accurate picture of their rather meager advantages over placebo.

I’m also saying that we have yet to understand the biological underpinnings of depression (or just about any major “mental disorder”, for that matter), and that we thus need to realize the limitations of current treatments.

The good news is that placebo itself is certainly a better treatment than nothing, so “not much better than placebo” is not all that insulting. But it does point out that the so called active ingredients in antidepressant treatment (both psychological and pharmacological) are not the most important factors. Antidepressant treatment often works, but we’re kidding ourselves to think that we generally know why it works.

Mark, thanks for your comments as well. You pointed to some good resources. I’d say that sugar pills don’t generally yield better outcomes than antidepressants (see link above) though that has happened on occasion. And, of course, when placebo does beat a pill, you’ll almost never see such a result get published, as the sponsor wouldn’t dare let such poor publicity occur.

Anonymous, you are correct in that the endocrine feedback loop appears to be off in many cases of depression. However, it is also my recollection that the feedback loop is also off in other conditions as well, so it is not particularly specific to depression. On this point, I am a bit rusty and could well be wrong. Regarding tryptophan, I thought (again, I’m rusty on this point as well) that it showed some antidepressant properties, but that it did not by any means outperform placebo to a large degree. So I’m not so sure that amino acid based treatments would be a breakthrough treatment. As you aptly noted, due to factors well outside of science, such treatments are not widespread.

A Chemical Imbalance Neither GlaxoSmithKline or the MHRA can give answers as to what constitutes a proper chemical imbalance of serotonin in the brain - weird because Seroxat is prescribed for this 'disorder'

The only thing that I can see is that Seroxat actually causes the chemical imbalance rather than rectifies it - A genius piece of marketing by GSK.

Prescribe a drug

Let the patient get hooked on the drug

Play down the risks by producing clinical trial studies beneficial to GSK

Employ ghost writers and patient support groups to back up the benefits of taking Seroxat

Robustly deny Seroxat causes aggression, suicidal tendancies etc

Always settle out of court for any litigation

Infiltrate the Medicines Regulatory Agency with former employees of GSK

Fund the government

Financially secure to research and market more SSRi type drugs

Credit where it is due, the marketing team at GlaxoSmithKline are without doubt highly skilled at manipulating doctors and the general public.

They don't even klnow how Seroxat works - they are just pleased that it does work. Cases where it hasn't worked - infact quite the reverse, seem to go unoticed - until the invention of the internet that is.

The MHRA are proud of the Yellow Card system - Why?

It is a completely flawed system and they only act on less than half of the Yellow Card reports.

A more robust system would be for the MHRA to employ a person or persons with a basic grasp of internet seaching. Then, they will see the REAL suffering from the REAL people.

Alas, they have ties to GlaxoSmithKline, namely Alistair Breckenridge and Ian Hudson. If they see GlaxoSmithKline have duped the public then they themselves have been duped by messrs Breckenridge and Hudson and that would cast a serious dark shadow on the MHRA's integerity.

They (The MHRA) have been investigating GlaxoSmithKline for nigh on four years now - my guess is they are waiting for a 'busy news day' until they release their findings. This way the story will be pushed to some small article in the tabloids.

It is utterly shameful of any human being to cause human suffering. Both GlaxoSmithKline and The MHRA have continued to deny Seroxat is harmful in the adult population - forget the clever spin 'dangerous in young adults'.

GlaxoSmithKline are currently being sued through the courts both here in the UK and in the United States. It now needs a firm of solicitors with huge balls to sue the MHRA. There is enough evidence I'm sure to successfully bring them to trial.

The Mind Resonance Process worked out by Dr. Nick Arrizza works fine for several psychiatric problems. Takes about an hour to do. Dr. Nick first degreed in Chem. Eng, then got an MD and then became a psychiatrist.

Organizations

Scientific Misconduct

About Me

I'm an academic with a respectable amount of clinical experience and no drug industry funding. Given my lack of time, don't expect multiple daily updates. Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts, and you'll probably pick up on these pet peeves before long...